Sec. 502. Development of certain methodologies, guidelines, and standards
210 words·~1 min read·
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The Council shall adopt methodologies for profiling the patterns of practice of health care professionals and for identifying outliers (as defined in subsection (e)). The Council shall develop guidelines for certain medical procedures designated by the Board to be performed only at tertiary care centers which can meet standards for frequency of procedure performance and intensity of support mechanisms that are consistent with the high probability of desired patient outcome. Reimbursement under this Act for such a designated procedure may only be provided if the procedure was performed at a center that meets such standards.
The Council shall develop standards for education and sanctions with respect to outliers so as to ensure the quality of health care services provided under this Act. The Council shall develop criteria for referral of providers to the State licensing board if education proves ineffective in correcting provider practice behavior. The Council shall disseminate to the State— the methodologies adopted under subsection (a); the guidelines developed under subsection (b); and the standards developed under subsection (c); for use by the States under section 503.
In this title, the term outlier means a health care provider whose pattern of practice, relative to applicable practice guidelines, suggests deficiencies in the quality of health care services being provided.